Aid worker stories

Portable, practical, inflatable: surgery in the bubble

Suregery in the BubblePerforming surgery in a plastic bubble and other portable, practical solutions used by doctors in emergencies, by RedR Member and MSF engineer Paul Jawor.

In Syria people are dying of injuries caused by tank shelling, aerial bombardment and shrapnel. These injuries sound horrific to you or me, but they don’t have to be fatal. Quick access to surgery could save a lot of lives.

But all the hospitals in the major cities have been bombed time and time again, and medical equipment, and the buildings themselves are badly damaged. MSF doctors in Syria say most hospital walls, and often roofs have large bullet holes in them.

Surgery has to be performed in a completely sterile environment, which is impossible to create in these bombed-out hospitals. That’s why we’re piloting the use of plastic altitude chambers. 
Top tennis players like Nadal and Djokovic use them to train in. The way they work is that the air pressure inside the chamber can be manipulated to replicate the air pressure at high altitude. Since the human body adapts to low oxygen by increasing the number of red cells in the blood, this raises aerobic performance. So if an athlete trains on a running machine inside one it will boost their fitness.

We used to perform surgery in old shipping containers, because they offered us a small, sealed space in which to try and create sterile conditions. But we’ve found that the risk of infection is actually quite high because you can’t ever eradicate all the bacteria inside it.

Because the plastic bubble is airtight, we can completely control the environment within it. If we pump specially filtered air into it, in the same way that Nadal might pump in low-oxygen air for training purposes, we can create the perfectly sterile conditions our surgeons need to work in. The bubble is always set up inside an existing hospital to protect patients and surgeons from tanks, grenades and gunfire on the streets outside.

The bubble has a capacity of 6 square metres. Just big enough for a surgical bed, lights and a couple of surgeons to move around in. We link two bubbles together, so you can scrub up in the first one, and operate in the second one.

When you test drive something there’s an ethics question. You can’t use the people you’re trying to help as guinea pigs for something you don’t know works yet. So we’re not going to perform critical surgery in the bubble yet, we need to prove it does what we think it does first.

We wanted to pilot these during the war in the Central African Republic a few years ago, but we couldn’t do it, because of the security issue  – the fighting was happening in the forest, and rebels would’ve shot at it if they’d seen a plastic bubble in the middle of a forest. In Syria we knew there were enough shelled buildings to hide our bubbles in. All environments we operate in are different, you often have to adapt new equipment to fit a new situation.

Surgery in the BubbleFor instance, right now we’re designing a Rigid Inflatable Boat Ambulance. It’ll carry two patients on stretchers, a medical kit & an IV drip-line. We might put an oxygen tank on it, we’re still trying to decide whether it’s worth the risk. Travelling at high speed, the tank could easily fall off the boat, and if it’s anywhere near a source of fire there’ll be an enormous, highly dangerous explosion. 

The RIB ambulance will be used in countries where river access is a lot easier than road access like Colombia and the Democratic Republic of Congo. It’ll just be used for transporting people, not for medical procedures that you can do on a conventional ambulance. You can’t create a sterile environment on an open boat. It’ll never be as good as a conventional ambulance, but it will save lives in remote rural communities where people die because the journey to hospital by road can take days.

It’s a cheap, effective, short-term solution a bit like superglue. I’ve heard superglue was invented during the Vietnam war as a quick fix solution on the battlefield, for sealing wounds and preventing excessive blood loss, or sticking peoples’ limbs back on temporarily while they were being transported to hospital. Once they got there the surgeons operated on the wound or detached the limb and sewed it back on properly.  In emergencies, quick-fixes save lives, and the more portable they are, the better. 

This blog first appeared in The Engineer.



Photo credits: Paul Jawor

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